Why the study?
The clinical relevance of and optimal treatment strategy for coronary artery disease in low- and intermediate-risk patients undergoing TAVR for severe aortic stenosis remain unclear.
Does complete percutaneous coronary revascularization within 3 months prior to TAVR affect 2-year all-cause mortality compared to having no or non-significant CAD in low- and intermediate-risk patients with severe aortic stenosis?
Observational (n=449)
No
Does complete percutaneous coronary revascularization within 3 months prior to TAVR affect 2-year all-cause mortality compared to having no or non-significant CAD in low- and intermediate-risk patients with severe aortic stenosis?
Complete percutaneous coronary revascularization shortly before TAVR is feasible and results in neutral 2-year all-cause mortality compared to patients without significant CAD in low- and intermediate-risk TAVR recipients.
Answers are grounded in this paper and cite their sources.
Complete pre-TAVR PCI was associated with similar mortality in low- and intermediate-risk patients; leaves open benefit of routine revascularization in randomized trials.
The clinical relevance of as well as the optimal treatment strategy for coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) are unclear. Current data are conflicting, and mainly derived from high-risk patients. We aimed to investigate the feasibility and safety of complete revascularization prior to TAVR for severe AS in low- and intermediate-risk patients. We enrolled 449 patients at low (STS score < 4%) and intermediate risk (STS score 4–8%) undergoing TAVR for severe AS and investigated the influence of recent (<3 months) and prior (>3 months) complete revascularization on clinical outcome. Primary study endpoint was all-cause mortality. Overall, 58% of patients had no or non-significant CAD; 18% had a history of complete revascularization prior to TAVR and 24% had complete revascularization shortly before TAVR. Two-year all-cause mortality was not different between patients with recent revascularization prior to TAVR and patients with no or non-significant CAD (13.7% vs. 14.2%, p = 0.905). Cox regression did not reveal an effect on all-cause mortality for recent revascularization. The present analysis reassures that percutaneous complete revascularization prior to TAVR procedures is neutral in terms of all-cause mortality in patients at low and intermediate surgical risk.
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Winter et al. (2021) conducted an observational in Severe degenerative aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) (n=449). Complete percutaneous coronary intervention (PCI) within 3 months prior to TAVR vs. No or non-significant coronary artery disease (CAD) was evaluated on 2-year all-cause mortality (HR 1.201, 95% CI 0.683-2.111, p=0.525).
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